 |
| Interpretation
of Toxicology Results |
|
The following table is provided only as a guide.
Drug
Reference: A-C D-F
G-K L-N
O-Q R-Z
View
the list by scrolling down the page or use the hotlinks above.
| DRUG
(Reference) |
ASSAY |
THERAPEUTIC
(mg/L) |
TOXIC
(mg/L) |
LETHAL
(mg/L) |
COMMENTS |
Acetaminophen
(1,2,3,5) |
N |
1-52 |
30-300 |
90-320
(170) |
The
toxic effects of acetaminophen are often seen 2-4 days after
ingestion and blood levels may not be extremely high at time
of death. |
Alprazolam
(1,2,4,5) |
E |
0.005-0.11 |
0.008-0.64 |
0.12-2.1
(0.55) |
The
concentrations listed as toxic are from driving under the influence
(DUID) cases. Only 30%
of those arrested had concentrations greater than 0.10 mg/L.
|
Amantidine
(1,3,5) |
B |
0.1-1.0 |
1-5 |
21-48
(33) |
|
| Amitriptyline
(1,2,3,5) |
B |
0.01-0.25 |
>1 |
>2 |
Significant
postmortem redistribution can occur with all tricyclics. PB and LVR may be required to resolve difficult
cases. |
| Amoxapine
(1,5) |
B |
0.01-0.6 |
0.3-2.9
(1.6) |
0.9-20
(6.9) |
Significant postmortem redistribution can occur with this drug.
PB and LVR may be required to resolve difficult cases.
|
| Amphetamine
(1,2,3,5) |
B |
0.05-2.0 |
0.2-3 |
0.5-41(8.6) |
Tolerance is important to consider when evaluating the toxicity
of this drug.Cardiotoxic with ethanol consumption.
|
| Arsenic
(1,3) |
S
|
0.002-0.062;
0.27 (herbicide workers) |
|
>0.6-9.3
(oral); >0.1 (arsine) |
Detection
of chronic arsenic poisoning is complex. Blood specimens alone
are insufficient. Tissues and/or hair are usually required.
|
| Benztropine
(1) |
B
|
0.008-0.13
(0.1) |
0.1
|
0.2-1.1
(0.5) |
|
| Bupropion
(1,5) |
B
|
0.05-0.4 |
0.19-0.22 |
4-13
(7.3) |
Postmortem redistribution can occur with this drug. PB and LVR
may be required to resolve difficult cases.
|
| Buspirone
(1,4,5) |
B |
0.0005-0.003 |
|
|
|
| Butalbital
(1,3,4,5) |
A
|
1-5
|
0.1-28
(8.5) |
13-30
|
|
| Butorphanol
(1,3) |
S
|
<0.002 |
|
0.005 |
|
| Caffeine
(1,2,3,4,5) |
B
|
12-30 |
50-400 |
79-344
(183) |
|
| Carbamazepine
(1,2,3,5) |
N |
2-12 |
3-77
|
35-70
(45) |
|
| Carbon
Monoxide (1,3,5) |
S
|
<10
% SAT |
15-25
% SAT |
50
% SAT |
smokers:5-6%
|
| Carisoprodol
(1,2,3,5) |
N
|
2.6-30 |
2.6-15 |
>30
|
Tolerance is important to consider when evaluating the toxicity
of this drug. The concentrations listed as toxic are from driving
under the influence (DUID) cases.
|
| Chlordiazepoxide
(1,2,3,4,5) |
B
|
0.4-3.0
|
1-66 |
>20 |
|
| Chlorpheniramine
(1,5) |
B
|
0.01-0.02
|
0.5 |
>0.5 |
Significant postmortem redistribution can occur with this drug.
PB and LVR may be required to resolve difficult cases.
|
| Chlorpromazine
(1,2,3,5) |
B
|
0.02-0.30
low dose 0.75 high dose |
0.5-3.0 |
>1(mean=
5.0) |
Liver levels can usually differentiate high chronic vs. fatal
cases.Significant postmortem redistribution can occur with this
drug. PB and LVR may be required to resolve difficult cases.
|
| Citalopram
(1,2,5) |
B
|
<1 |
1.0-4.0
|
>4.0
|
Significant postmortem redistribution can occur with all SSRI's.
PB and LVR may be required to resolve difficult cases. The concentrations
listed as toxic are from driving under the influence (DUID)
cases.
|
| Clomipramine
(1,2,3,5) |
B
|
<0.3 |
1
|
2
|
Significant postmortem redistribution can occur with all tricyclics.
PB and LVR may be required to resolve difficult cases.
|
| Clonazepam
(1,3,4,5) |
S
|
0.01-0.2 |
>0.1
|
>0.3-10
(+mtb.) |
Usually present as mtb. only. The concentrations listed as toxic
are from driving under the influence cases.
|
| Clorazepate
(1,3,4,5) |
B
|
0.12-2.0
(nordiazepam) |
>5
|
|
Prodrug
for nordiazepam. No reported OD for this drug taken alone.
|
| Clozapine
(1,2,4,5) |
B
|
0.06-1.0 |
0.6-9.5 |
1.2-13
|
Significant postmortem redistribution can occur with this drug.
PB and LVR may be required to resolve difficult cases.
|
| Cocaine
(1,3,4,5) |
E
|
0.1-1.0 |
0.1-5
|
>0.9
|
"Concentrations
listed include the cocaine metabolites
benzoylecgonine and ecgonine methyl ester."
|
| Codeine
(1,2,3,4,5) |
E
|
0.03-0.4 |
0.2 |
1-8.8
(2.8) |
|
| Cyanide
(1,3,5) |
S
|
<0.04 |
0.5
|
"1.1-5.3
(oral);
1-15 (inhalation)" |
|
| Cyclizine
(1,3,5) |
B
|
0.01-0.3
|
|
15-80
(oral) 1.5 (IV) |
|
| Cyclobenzaprine
(1) |
B
|
<0.1 |
1
|
2
|
Significant postmortem redistribution can occur with all tricyclics.
PB and LVR may be required to resolve difficult cases.
|
| Desipramine
(1,2,3,5) |
B
|
0.1-0.8 |
0.4-2.0 |
3-16.8
(10.8) |
Significant postmortem redistribution can occur with all tricyclics.
PB and LVR may be required to resolve difficult cases.
|
| Dextromethorphan
(1,4,5) |
B
|
0.01-0.04 |
0.1
|
1.1-18
(3.5) |
May exhibit PMRD; PB and LVR may be required to resolve difficult
cases.
|
| Diazepam
(1,2,3,4,5) |
B
|
0.2-1.5
(low dose); 2-4 (high dose) |
3-5 |
>5 |
Diazepam only deaths are infrequent.
|
| Diethylpropion
(1,3) |
B
|
<0.2 |
2
|
5 |
|
| Diflunisal
(1) |
S
|
40
|
|
>260 |
|
| Digoxin
(1,3,4,5) |
S
|
0.0004-0.0023 |
0.0014-0.007
|
0.0015-0.03
|
Blood should be taken from a peripheral source. Vitreous is
also acceptable
|
| Diltiazem
(1,2,4,5) |
B
|
0.1-0.4 |
>1
|
6.7-33
(16) |
PMRD may occur, PB and LVR excellent complementary specimens
to resolve difficult cases.
|
| Diphenhydramine
(1,3,5) |
B
|
0.1-1 |
2-10 |
>8
|
Significant postmortem redistribution can occur. PB and LVR
excellent complementary specimen to resolve difficult cases.
|
| Doxepin
(1,3,5) |
B
|
<0.1 |
>1
|
2-26
(13) |
Significant postmortem redistribution can occur with all tricyclics.
PB and LVR excellent complementary specimens to resolve difficult
cases.
|
| Doxylamine
(1,5) |
B
|
0.05-0.8 |
1-2
|
0.7-12
(4.6) |
|
| Ephedrine
(1,2) |
B
|
0.1-0.6 |
|
5 |
|
| Ethchlorvynol
(1,3) |
S
|
5-20 |
18-163
|
22-213
(98) |
|
| Ethylene
glycol (1,3) |
S |
na |
|
>300 |
|
| Fenfluramine
(1,3,4,5) |
B
|
0.3 |
|
6.5 |
|
| Fentanyl
(1,4,5) |
E
|
0.001-0.0038 |
0.003
|
"0.002(IV);
>0.007(patch)" |
Tolerance is important to consider when evaluating the toxicity
of this drug.
|
| Flunitrazepam
|
S
|
0.02-0.05 |
|
0.01-1.6
|
Parent drug is rarely detected. Values given are for the 7-amino
flunitrazeapm metabolite
|
| Fluoxetine
(1,4) |
B
|
<1
(parent + mtb) |
0.2-0.4
|
2-6
|
Significant postmortem redistribution can occur with all SSRIs.
PB and LVR excellent complementary specimens to resolve difficult
cases. The concentrations listed as toxic are from driving under
the influence (DUID) cases.
|
| Fluphenazine
(1,5) |
S
|
0.02
|
0.1
|
0.1 |
|
| Fluvoxamine
(1,2) |
B
|
<0.9
|
0.3
|
3.4-16
|
Significant
postmortem redistribution can occur with all SSRIs. PB and LVR
excellent complementary specimen to resolve difficult cases.
The concentration listed as toxic is from a driving under the
influence (DUID) case.
|
| Gabapentin
(1) |
S
|
<20
|
45
|
>250 |
|
| Gammahydroxybutyrate
(1) |
S
|
20-52 |
>200
|
>400
|
Lethal levels lower with concomitant use of ethanol.
|
| Guaifenesin
(1) |
A
|
1.5
|
|
14
|
A lethal conc. of hydrocodone was also detected
|
| Haloperidol
(1,3,5) |
S
|
<0.1
|
0.05-0.5 |
0.2-1
|
|
| Heroin
(1,3) |
E
|
0.1
(morphine in chronic user) |
|
>0.1
(morphine) |
Tolerance
is important to consider when evaluating the toxicity of this
drug. Urine or bile are elecellent complimetary specimens to
use in distinguishing between morphine and heroin use.
|
| Hydrocodone
(1,3,4,5) |
E
|
<0.1 |
0.1
|
0.2-0.6
|
Tolerance is important to consider when evaluating the toxicity
of this drug.
|
| Hydromorphone
(1,3,4,5) |
S
|
<0.05 |
|
>0.1 |
Tolerance is important to consider when evaluating the toxicity
of this drug.
|
| Hydroxyzine
(1,2,3,5) |
B
|
0.1-0.4 |
1
|
2 |
|
| Ibuprofen
(1,3,5) |
S
|
<50
|
100-400 |
185-680 |
|
| Imipramine
(1,2,3,5) |
B
|
<
0.5 (parent + mtb) |
1
|
2.0-13
(4.5) |
Significant postmortem redistribution can occur with all tricyclics.
PB and LVR excellent complementary specimen to resolve difficult
cases.
|
| Ketamine
(1,2,3,5) |
B
|
<2.0 |
|
7-10
|
Nonmedical IV use can be lethal at conc. as low as 2.0 mg/L
|
| Lamotrigene |
A
|
5.6
(monotherapy) 2.3-9 (combo therapy) |
17
|
52 |
|
| Lidocaine
(1,2,5) |
B
|
2.0-5.0
|
>8.0
|
10-33
(20) |
|
| Lithium
(1,3,5) |
S
|
<1.3
mEq/L |
2.0
mEq/L |
2.4-8.0
mEq/L |
|
| Lorazepam
(1,5) |
S
|
<0.25
|
0.3-0.6 |
1.0-2.8
|
Lower toxic concentrations are found in cases of ingestion of
multiple respiratory depressants.
|
| Loxapine
(1,3) |
B
|
<0.1 |
0.2
|
2-8
|
Significant postmortem redistribution can occur. PB and LVR
excellent complementary specimens to resolve difficult cases.
|
| Meperidine
(1,4,5) |
B |
<0.50 |
4-8.6 |
8 (oral);
1-8 (IV) |
|
| Meprobamate
(1,2,3,4,5) |
N |
<25
|
25-60 |
35-240
(95) |
Tolerance
is important to consider when evaluating the toxicity of this
drug. DUID cases reported to have meprobamate concentrations
of 35-96 mg/L.
|
| Methadone
(1,2,3,4,5) |
B |
0.01-1.06
|
|
0.06-3.1(0.28)
|
Significant
postmortem redistribution can occur. Liver is an excellent complementary
specimen to resolve difficult cases. Tolerance is important
to consider when evaluating the toxicity of this drug.
|
| Methamphetamine
(1,3,5) |
B |
0.15-2.6 |
|
0.09-18 |
DUID cases
reported to have methamphetamine concentrations of 0.05-2.6
mg/L.
|
| Methanol
(1,3) |
S |
|
200 mg/dL |
200-630
mg/dL |
|
| Methylenedioxy-methamphetamine
(1) |
B |
|
0.08 |
0.6-2.8
(1.8) |
The concentration
listed as toxic is an average value from driving under the influence
(DUID) cases.
|
| Metoprolol
(1,3,4,5) |
B |
0.03-0.5
|
12-18 |
4.7-142 |
|
| Midazolam
(1,2,4,5) |
E |
0.05-0.1
|
0.03-0.4
|
0.07-0.35 |
|
| Mirtazapine
(1,5) |
B |
0.1-0.2 |
0.1 |
2.1-12
|
The concentration
listed as toxic is from a driving under the influence (DUID)
case.
|
| Morphine
(1,3,4,5) |
E |
0.01-0.05
|
0.1 |
0.1-4 |
Tolerance should be considered when evaluating the toxicity of this drug.
|
| Naproxen
(1,3,4,5) |
S |
<90
|
400 |
|
|
| Nefazadone
(1) |
B |
2 |
5 |
7 |
|
| Nicotine
(1,3,5) |
B |
0.044 |
0.3-0.4
|
1.4-63
|
Lower
toxic concentrations are associated with transdermal patch use.
|
| Nifedipine
(1,5) |
S |
<0.1
|
0.15 |
0.15-0.27 |
|
| Nortriptyline
(1,2,3,5) |
B |
0.05-0.25
(0.18) |
0.5-1.3
|
1.6-4 (3.8)
|
Significant
postmortem redistribution can occur with all tricyclics. Liver
is excellent complementary specimen to resolve difficult cases.
|
| Olanzapine
(1,5) |
B |
0.1-0.4
|
0.05-1.0
|
1.0-4.9
|
Freeze
specimen to prevent analyte degradation:
|
| Oxazepam
(1,2,3,4.5) |
E |
0.1-1.4 |
0.2-8.0
|
4.4-6.1
(5.3) |
The concentrations
listed as toxic are from driving under the influence (DUID)
cases.
|
| Oxcarbazepine |
N |
8-12 (mtb)
|
46 |
2.5 (parent)
92 (mtb) |
10-OH
carbazepine metabolite (mtb) accumlates with chronic dosing,
whereas, parent analyte does not.
|
| Oxycodone
(1,3,4,5) |
B |
0.05-0.1 |
0.01-0.5
(0.24) |
0.12-2.7
(0.84) |
Tolerance
is important to consider when evaluating the toxicity of this
drug. The concentrations listed as toxic are from driving under
the influence (DUID) cases.
|
| Paroxetine
(1,2,5) |
B |
0.1-0.6
|
|
0.7-4.6
|
Significant
postmortem redistribution can occur with all SSRIs Liver is
excellent complementary specimen to resolve difficult cases.
|
| Pentobarbital
(1,2,3,4,5) |
A |
1-5 |
10-19 |
10-51 |
|
| Phencyclidine
(1,3) |
S |
na |
0.01-0.24 |
0.3-25 |
|
| Phenobarbital
(1,2,4,5) |
A |
6-40 |
30 |
>60 |
|
| Phentermine
(1,3,4) |
B |
0.18-0.51
|
0.2 |
1.5-7.6 |
|
| Phenylpropanolamine
(1,2,3,5) |
B |
0.1 |
2 |
>2 |
|
| Phenytoin
(1,2,3,5) |
A |
10-20 |
20-50 |
>70
|
|
| Primidone
(1,3,5) |
A |
5-15 |
20-50 |
65 |
|
| Procainamide
(1,3,5) |
S |
4-10 |
10-16 |
17-260
(100) |
|
| Promethazine
(1,2,4,5) |
B |
<0.5
|
1 |
2.4-12 |
|
| Propoxyphene
(1,2,5) |
B |
0.13-1.0
|
>1 |
>2 (parent
only) |
|
| Propanolol
(1,2,4,5) |
B |
0.34 |
1-3 |
2-4 |
|
| Pseudoephedrine
(1,3) |
B |
<1 |
|
10 |
|
| Quetiapine
(1) |
B |
<1 |
|
5-49 |
PMRD may
occur, PB and LVR excellent complementary specimens to resolve
difficult cases.
|
| Quinidine
(1,3,4,5) |
B |
<3 |
6-10 |
10-45 |
|
| Quinine
(1,3,5) |
B |
1-10 |
>10
|
6-24 |
|
| Risperidone
(1) |
S |
0.04-0.11 |
1.8 |
|
|
| Salicylate
(1,2,3,5) |
S |
10-300 |
>200 |
400-7300
(600) |
Higher
conc. are with arthritic patients that have been titrated to
this level (44-330).
|
| Sertraline
(1) |
B |
<0.5
|
|
>1.5
(parent only) |
PMRD may
occur, PB and LVR excellent complementary specimens to resolve
difficult cases.
|
| Temazepam
(1,3,4,5) |
E |
0.2-1.0
|
1 |
3-14 |
|
| Theophylline
(1,2,3,5) |
N |
4.0-10 |
>20
|
>50 |
|
| Thioridazine
(1,2,5) |
B |
0.14-2.6 |
2.8-14
|
2.4-10
(4.0) |
PMRD may
occur, PB and LVR excellent complementary specimen to resolve
difficult cases.
|
| Topiramate |
A |
30 |
|
|
|
| Tramadol
(1,5) |
B |
0.1-0.8 |
0.1-0.9 |
1.4-23
|
The concentrations
listed as toxic are from driving under the influence (DUID)
cases.
|
| Trazodone
(1,3,5) |
B |
<2.5
|
19-26 |
9.4-34
|
PMRD may
occur, PB and LVR excellent complementary specimens to resolve
difficult case. The concentrations listed as toxic are from
overdose cases in which the patient survived with supportive
therapy.
|
| Triazolam
(1,3,5) |
E |
<0.02
|
0.004-0.04 |
0.01-0.22 |
The concentrations
listed as toxic are from driving under the influence (DUID)
cases.
|
| Trichlorethanol
(1,2) |
S |
2-27 |
330 |
20-640
(250) |
Mtb. of
chloral hydrate. Significant postmortem redistribution can occur.
PB and LVR may be required to resolve difficult cases.
|
| Trimipramine
(1,2,3,5) |
B |
0.011-0.241
|
0.5-1.0
|
1.1-12
(5.0) |
PMRD may
occur, PB and LVR excellent complementary specimens to resolve
difficult cases.
|
| Valproic
acid (1,3,5) |
S |
50-100
(plasma) 27-50 (whole blood) |
52-148
(hepatotoxic); 482-2120 (coma) |
720-1969 |
|
| Venlafaxine
(1,5) |
B |
<1 |
6-12 |
6.6-89
(45) |
PMRD may
occur, PB and LVR excellent complementary specimens to resolve
difficult cases.
|
| Verapamil
(1,2,4,5) |
B |
0.1-1.0 |
1-4 |
0.9-85
(11) |
|
| Zaleplon |
S |
<0.3
|
|
>1 |
|
| Zolpidem
(1,2,4,5) |
B |
<0.3
|
0.07-0.7 |
>1 |
The concentrations
listed as toxic are from driving under the influence (DUID)
cases. Tolerance should be considered when evaluating the toxicity
of this drug.
|
References:
1.
Baselt RC. Disposition of Toxic Drugs and Chemicals in Man, 6th
ed. Biomedical Publications, Foster City, CA, 2002.
2.
Druid H, Holmgren P. A Compilation of Fatal and Control Concentrations
of Drugs in Postmortem Femoral Blood. J Forensic Sci 1997;42:79-87.
Druid H, Holmgren P, Hallander S, Ahlner J. Interpretation of postmortem
femoral blood concentrations of newer antidepressants and hypnotics.
American Academy of Forensic Sciences, February, 2001.
3. Stead AH, Moffat AC. A Collection of Therapeutic, Toxic and Fatal
Blood Drug Concentrations in Man. Human Toxicol 1983;3:437-464.
4. Repetto MR, Repetto M. Habitual, Toxic, and Lethal Concentrations
of 103 Drugs of Abuse in Humans. Clin Toxicol 1997;35:1-9.
5. Schultz M, Schmoldt A. Therapeutic and Toxic Blood Concentrations
of More than 500 Drugs. Pharmazie 1997;52:895-911.
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